It seems like only yesterday that the AIDS pandemic first hit— arriving in a storm of panicked media exclusives and misinformation. As with any communicable, life-threatening disease, the public’s first questions were inevitably ‘have I been exposed?’ or, even, ‘could I already have AIDS without knowing?’ In the beginning, there was little clear information on where the disease came from, or how it was spread—only the grim knowledge that people were dying. The absurd—and often mocked—notion the illness could be contracted through a toilet seat or drinking fountain seemed very valid and real—and would only later be dispelled through many years of public education and AIDS literacy campaigns.

25 years later, World AIDS Day celebrated the anniversary of its founding in 1987—marking an important global milestone for AIDS research, awareness and fundraising. The little red ribbon can be seen everywhere— from Vancouver to Helsinki— and AIDS is now a treatable disease with a vastly improved prognosis. With modern retroviral therapy, many patients are living past the 20-year mark. Of course, there’s still much to be done, especially in developing nations where these drugs are often not available—mostly due to financial or political concerns.

While the public is aware of AIDS and its health implications around the world, few are aware of the role that bacteria play in the everyday lives of patients. With the gradual loss of CD4 white blood cells, which help direct the immune system, AIDS patients are less able to mount an effective defense against common bacteria and are, accordingly, more prone to developing infections. The net result of this vulnerability is increased antibiotic treatment among patients and, in turn, increased antibiotic resistance.

A 2008 study that appeared in the American Journal of Medicine, for example, found an abnormally high incidence of MRSA infection among AIDS patients with skin abscesses. According to the study, 74.2% were positive for CA-MRSA, or Community-Acquired MRSA. The high degree of antibiotic resistance was quite shocking to the group. In their own words: “Even more interesting and worrisome was the high degree of resistance to the other antibiotics, many of which have been previously recommended for known or suspected MRSA infections.”

E. coli is another bacterium with a special relationship to AIDS. Often, to lower the risk of bacterial infection among AIDS patients, doctors prescribe the inexpensive sulfa drug, cotrimoxazole. While this antibiotic prophylaxis has been credited for saving many lives, it also quickly leads to sulfa drug resistance in e. coli bacteria. A 2008 study from Tanzania, which uses this method, shows that e.coli strains in the local population— for both HIV positive and HIV negative individuals — are less susceptible to sulfa drugs. Once antibiotic therapy begins in an HIV positive individual, these strains begin to move towards full resistance to the drug. A similar phenomenon exists in Jamaica, among HIV-positive children with urinary tract infections. Since e. coli is a common bacterial cause of UTIs, it’s not surprising that resistance, and subsequent infection, would develop in patients treated with sulfa drugs. The same 2010 study goes on to describe e.coli resistance to sulfa drugs at 2 out of 3 clinical sites.

As a population at increased risk of developing life-threatening bacterial infections, AIDS patients present a formidable challenge to the question of antibiotic resistance. As the e. coli studies, above, show, AIDS patients have a unique and often dangerous relationship with bacteria— whether it’s their body’s own natural flora, or invasive, community-acquired infections. Approaching resistance as a whole—from misuse in animal feed and livestock to over-prescription in medical spheres— may go a long way towards saving AIDS patients’ lives, as well as guaranteeing the future effectiveness of antibiotics for everyone.